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Toll Free Number: 1800 203 0007

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Health insurance Cashless claim

“A cashless claim in health insurance ensures that in times of medical emergencies, financial worries take a back seat while healthcare remains the priority.”

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What is a Cashless Claim

A cashless claim in health insurance is a facility where the policyholder does not have to pay upfront for medical expenses at a network hospital. Instead, the insurance company settles the bill directly with the hospital, subject to the policy’s terms and conditions.

How it works:

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    Select a Network Hospital – Treatment can be availed at any network hospital within Galaxy Galaxy Health Insurance network.

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    Pre-authorization – For planned treatments,Galaxy Health Insurance must be notified in advance. In case of emergency, the hospital’s insurance desk will co-ordinate with us for quick and swift approval.

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    Approval Process – Galaxy Health Insurance verifies the claim and approves expenses as per the policy coverage.

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    Treatment & Bill Settlement – Once the claim is approved for the treatment of the insured patient, the bill is settled directly to the hospital, as per the approval authorized.

Cashless Claim Process in Health Insurance

1

Initiating

Insured contacts Network Hospital Insurance Desk with Health Card / Policy details

2

Submission

Hospital submits the duly filled Pre - authorization form to the Galaxy Health Insurance with policy details

3

Claim Processing

Claim processing as per policy terms and conditions

4

Decision

Approval / Query / Rejection / Denial

Cashless Claim Process in Health Insurance

Steps Process

1

Insured member may visit a network hospital for treatment

2

He /she can approach the Insurance / TPA desk at the hospital and present a copy of the Galaxy Health Insurance policy / Health card along with the medical documents and a request to avail cashless claim benefit

3

The Insurance / TPA desk of the hospital shall complete the preauthorisation form and submit it along with the policy details to Galaxy Health Insurance

4

As soon as Galaxy Health Insurance receives the details, Galaxy Health Insurance records the intimation and registers the claim

5

A communication regarding the claim is sent to the Policyholder/ Insured’s registered mobile number

6

Galaxy Health Insurance will review the documents received in connection with the claim, verify the information and decide on the admissibility of the claim based on the policy terms and conditions

7

The decision on the claim is communicated both to the hospital as well as to the Policyholder/ Insured through a letter of approval. Or a query may be raised if additional documents are needed. If the claim is not admissible based on the policy terms and conditions, it would be notified to the Policyholder/Insured

8

If a query is raised for additional documents, the hospital shall submit the required information and Galaxy Health Insurance Claims team shall process the claim accordingly

9

The Policyholder/ Insured shall be apprised of the claim status at every stage through SMS/ email

10

Once the claim is approved, Policyholder/ Insured shall be informed if he/she has to pay any difference amount on account of non-payable charges

11

If the claim is approved in full by Galaxy Health Insurance, no payment shall be collected from the Policyholder/ insured

Disclaimer

The content provided on this website is for informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any insurance products. Health insurance policies and plans are subject to underwriting and approval by Galaxy Health Insurance. The terms, conditions, exclusions, and benefits of each policy may vary based on disclosure by the prospect and plan selected.

For more details on terms and conditions please read the sales brochure carefully.

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